【持续性肾脏替代治疗CRRT英文精品课件】Acute Kidney Injury(91p)
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Sudden rapid drop in GFR, as measured by serum creatinine level, over hours to days.
Pathophysiology
Pathophysiology
AKI: Pathophysiology
Reasons for AKI Consults (n = 748)
AKI: Intra Renal
Glomerular Vascular Tubules Interstitial
Intra Renal- Glomerular Disease
Pathology:
Focal and diffuse glomerulonephritis Cresentic GN
Classic presentation
Fever, rash, eosinophilia Eosinophiluria Definitive Dx = renal biopsy
AKI: Interstitial Nephritis
AKI:wk.baidu.comInterstitial Nephritis
AKI: Post Renal
Intrinsic obstruction
Blood clots Stones/crystals Sloughed papillae Fungus balls
Extrinisic obstruction
Malignancy Retroperitoneal fibrosis Iatrogenic: inadvertent
Pre-renal Renal
ATN ARF or CRI GN AIN AED Obstruction
21%
45% 13%
4% 2% 1% 10%
Liano et al. Kidney Int 1996;50:811.
AKI: Prerenal
Prerenal
A. “True” Volume depletion
Pre-renal Renal: glomerular, tubular, interstitial and vascular. Post renal: obstruction.
Clinical features Investigations Treatment Prevention
AKI Definition
D.
- Congestive heart failure
E.
- Cirrhosis
F.
- Nephrosis
G.
- Sepsis/vasodilated states
Blood Volume
Cardiac Pump dysfunction
Vasodilation
Glomerular autoregulation
Anuria - important finding
Common causes of obstruction
Prostatic obstruction Cancer Retroperitoneal disease
Dx = ultrasound
Post Renal AKI
Ureteral and pelvic
85% - intrinsic AKI Histologic changes
Epithelial sloughing Luminal occlusion Common causes Ischemia Toxic
Rhabdomyolysis/myoglobinuria
AKI: Tubules
Tubular obstruction
a) Crystal induced tubular obstructions Allopurinol, sulpha, HIV meds, methotrexate
AKI: Acute Interstitial Nephritis
10% - intrinsic ARF
ATN
a) Neprotoxic agents Drugs: Amphotercin, aminoglycosides Myoglobin, hemoglobin, radio-contrast
b) Ischemic injury Prolonged prerenal state, Shock Arterial cross clamping during AAA and CABG Afferent arteriolar constriction sec to severe hypercalcemia.
ligation
• Bladder
• Stones • Blood clots • Prostatic
hypertrophy or malignancy • Bladder carcinoma • Neuropathic • Urethral • Strictures • Phimosis
A. - Blood loss B. - GI or Renal losses
History Dry mucosa, skin turgor Hypotension Oliguria
B. Intravascular Volume Depletion
History
C. Effective circulating volume depletioEndematous states
Acute Kidney Injury
N. Ganesh Yadlapalli, M.D. Assistant Professor of Medicine
University of Cincinnati
Overview of AKI
Definition of AKI Pathophysiology
Hallmark:
Red blood cell casts Hematuria, HTN
Intra Renal - Vascular Disease
Common causes:
Malignant HTN Vasculitis Thromboembolic disease
Intra Renal --Acute Tubular Necrosis
Pathophysiology
Pathophysiology
AKI: Pathophysiology
Reasons for AKI Consults (n = 748)
AKI: Intra Renal
Glomerular Vascular Tubules Interstitial
Intra Renal- Glomerular Disease
Pathology:
Focal and diffuse glomerulonephritis Cresentic GN
Classic presentation
Fever, rash, eosinophilia Eosinophiluria Definitive Dx = renal biopsy
AKI: Interstitial Nephritis
AKI:wk.baidu.comInterstitial Nephritis
AKI: Post Renal
Intrinsic obstruction
Blood clots Stones/crystals Sloughed papillae Fungus balls
Extrinisic obstruction
Malignancy Retroperitoneal fibrosis Iatrogenic: inadvertent
Pre-renal Renal
ATN ARF or CRI GN AIN AED Obstruction
21%
45% 13%
4% 2% 1% 10%
Liano et al. Kidney Int 1996;50:811.
AKI: Prerenal
Prerenal
A. “True” Volume depletion
Pre-renal Renal: glomerular, tubular, interstitial and vascular. Post renal: obstruction.
Clinical features Investigations Treatment Prevention
AKI Definition
D.
- Congestive heart failure
E.
- Cirrhosis
F.
- Nephrosis
G.
- Sepsis/vasodilated states
Blood Volume
Cardiac Pump dysfunction
Vasodilation
Glomerular autoregulation
Anuria - important finding
Common causes of obstruction
Prostatic obstruction Cancer Retroperitoneal disease
Dx = ultrasound
Post Renal AKI
Ureteral and pelvic
85% - intrinsic AKI Histologic changes
Epithelial sloughing Luminal occlusion Common causes Ischemia Toxic
Rhabdomyolysis/myoglobinuria
AKI: Tubules
Tubular obstruction
a) Crystal induced tubular obstructions Allopurinol, sulpha, HIV meds, methotrexate
AKI: Acute Interstitial Nephritis
10% - intrinsic ARF
ATN
a) Neprotoxic agents Drugs: Amphotercin, aminoglycosides Myoglobin, hemoglobin, radio-contrast
b) Ischemic injury Prolonged prerenal state, Shock Arterial cross clamping during AAA and CABG Afferent arteriolar constriction sec to severe hypercalcemia.
ligation
• Bladder
• Stones • Blood clots • Prostatic
hypertrophy or malignancy • Bladder carcinoma • Neuropathic • Urethral • Strictures • Phimosis
A. - Blood loss B. - GI or Renal losses
History Dry mucosa, skin turgor Hypotension Oliguria
B. Intravascular Volume Depletion
History
C. Effective circulating volume depletioEndematous states
Acute Kidney Injury
N. Ganesh Yadlapalli, M.D. Assistant Professor of Medicine
University of Cincinnati
Overview of AKI
Definition of AKI Pathophysiology
Hallmark:
Red blood cell casts Hematuria, HTN
Intra Renal - Vascular Disease
Common causes:
Malignant HTN Vasculitis Thromboembolic disease
Intra Renal --Acute Tubular Necrosis